Obamacare: will it help, will it hurt

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ST. JOHN VALLEY- Health care in the United States has become a highly charged topic. The issue of whether the nation has a responsibility to ensure all citizens have access to some basic level of health care, and therefore whether all citizens have a responsibility to pay into a system to ensure this, is a controversial debate.

 A 2007 article on the CATO Institute's website says, “health care and health insurance are not synonymous.”

Regardless, in the ongoing debate, reform of the medical insurance industry is where politicians and other interested parties currently focus most of their energy around the discussion.

Many Mainers may be unaware that the health care legislation popularly called “Obamacare” and otherwise known as the Patient Protection and Affordable Care Act (PPACA) was passed into law on March 23, 2010. Provisions of that law have already gone into effect, and others are proposed to take effect through 2018-2019.

The most controversial item in the conversation around health insurance reform up until this point reached its peak on June 28, 2012, when the U.S. Supreme Court ruled in National Federation of Independent Business vs. Sebelius that the individual health insurance mandate associated with the PPACA is constitutional under Congress’ given powers to lay and collect taxes. The “individual mandate” is a requirement that those who can afford to pay for health insurance must do so, or face an annual penalty attached to their tax return.

For many residents in Aroostook County, one of Maine’s poorest counties, the prospect of trying to stretch already overstressed budgets to encompass the cost of health insurance is frightening.

However, to mitigate this, the PPACA also calls for an expansion of Medicaid coverage. According to the U.S. Supreme Court, Medicaid coverage under the PPACA will include a much wider range of eligible applicants than is currently possible under Medicaid guidelines, including adults without dependent children who make 133 percent of the Federal Poverty Level (FPL) or less ($14,484 for an individual or a couple making $19,572, according to the Federal Register).

Eva Bard at the Fort Kent office of the Maine Department of Human and Health Services (DHHS) said only citizens and others present in the country legally, including refugees and those seeking political asylum, are eligible for Medicaid in Maine. (The Supreme Court ruling states that federal Medicaid guidelines do not require Medicaid to be provided to legal aliens.)

The expansion of Medicaid coverage is a key component in what the Supreme Court ruling stated was the goal of the PPACA.

“In short, the Act attempts to achieve near-universal health insurance coverage by spreading its costs to individuals, insurers, governments, hospitals, and employers — while, at the same time, offsetting significant portions of those costs with new benefits to each group.”

In reality, Bard said Maine is facing an anticipated reduction in Medicaid services in the upcoming fall.

Although Medicaid expansion is a key component in the success of the PPACA and the Supreme Court acknowledges this, it ruled that states had to be allowed to opt out of the requirement to expand federal Medicaid funds if they didn’t want to do so, under the Court’s duty to maintain a system of federalism that gives states the power to determine how to govern their own people. The PPACA requires states to provide this expanded Medicaid funding and offers the federal funds to allow them to do so initially, but says that if they opt out of this funding, the dissenting states face losing all federal Medicaid monies, even for those groups currently covered by the program.

After the June 28 Supreme Court ruling, states now have the option to refuse to expand Medicaid coverage without losing all federal Medicaid monies. Unfortunately, because the rest of the PPACA was upheld, if states opt out of the expanded Medicaid program, this will have the net effect of requiring low-income people who are unqualified for the exemptions in the law to buy insurance under the gutted PPACA while others are still left without access to health insurance, as before the enactment of the PPACA, thereby crippling implementation of the intent of the law and potentially shifting costs in ways unintended by the legislation.

The Supreme Court ruling also says that “a State’s withdrawal [from the Medicaid expansion] might subject everyone in the State to much higher insurance premiums.” It is unclear whether Maine’s upcoming reduction in Medicaid benefits signals this pending situation for Maine residents.

According to the Henry J. Kaiser Family Foundation website, for low-income people required to buy insurance, the PPACA also provides low-cost health insurance options along with incentives for employers to provide insurance options for their employees.

Future articles in this series will provide an examination of the low-cost health insurance options, changes to existing health insurance requirements, and information on the situation employers are facing.

Also according to the Kaiser Foundation website, exemptions from the individual mandate will be granted for financial hardship (financial hardship is undefined, however), religious objections, American Indians, those without coverage for less than three months, undocumented immigrants (this group is also ineligible for Medicaid or Medicare), incarcerated individuals, those for whom the lowest cost plan option exceeds 8 percent of an individual’s income, and those with incomes below the tax filing threshold.

The Supreme Court ruling states that for those enrolled in government programs, such as Medicaid, or who have coverage under an employer-sponsored program, buying insurance under the individual mandate is unnecessary.

Specific questions about whether an individual or family living in the St. John Valley qualifies for Medicaid should be referred to a knowledgeable MaineCare representative. The office in Fort Kent is available at 834-7700. Medicaid qualifications are complex and involve assessments of applying individual and family assets, the age of the applicant(s), and medical bills. Children may qualify even though parents don’t, and different income level restrictions apply to different age groups.

The next article in this series will complete the introduction to this topic.